3 December 2020
Today, the Office for National Statistics (ONS) have launched the beta version of the Health Index. This, the first of its kind, aims to measure the total health of the nation, rather than just our illness. This groundbreaking and holistic way of looking at data will help us better understand the health of the England population .
The idea was first proposed by former Chief Medical Officer Dame Sally Davies in her 2018 Annual Report – Health 2040 – Better Health Within Reach, for which I was Chief Editor. The report stated: “We need to track progress in improving health and health outcomes, to and beyond 2040 with a new composite Health Index that reflects the multi-faceted determinants of the population’s health and equity in support of ensuring health is recognised and treated as one of our nation’s primary assets.” Dame Sally’s recommendation was based in the knowledge that good health is an asset to our economy, locally and nationally, yet despite this we don’t measure our ‘stock of health’ and how this varies across the country.
The Health Index is a composite measure that captures a broader definition of health, comprising three domains that together make up what drives our health albeit over different time horizons and in different ways. Within each domain are several domains and sub-domains with specific indicators such as those outlined below. The three domains are:
- Healthy people - health outcomes such as life expectancy, health conditions and personal well-being.
- Healthy lives - lifestyle, behaviour, modifiable risk factors.
- Healthy places - wider determinants of health, environmental factors.
While some of these indicators such as cancer mortality are directly influenced by the NHS, many are much wider than our healthcare system. This emphasises how the environment we live in shapes our ‘stock of health’ hence future economic prospects and that this varies across the country.
The index is weighted evenly across each of these three domains, each sub-domain and indicator with that. The index value, and for all domains, was set at 100 for England the year 2015. A higher number demonstrates an improvement in the nation’s health and a number below 100 demonstrates poorer health. The ONS have published data for the index for England for 2015-2018 with future plans to update to more recent data as well as to expand to all devolved nations across the UK.
The ONS have published the Index and a consultation document that you can find here. LCP has published an interactive platform to explore how and why the index varies over time and across the country available here.
England’s stock of health declined in recent years
The headlines from the publication of the Health Index are three fold;
- That our stock of health has not improved in recent years;
- There are large inequalities in health across England by geography and deprivation;
- The components making up our stock of health across local populations in England varies substantially.
The overall index for England has not improved over the past four years from 100 In 2015 to 99.7 in 2018 but there were mixed fortunes for the three components of the index. The healthy people domain worsened by 1.9 units over the period with improvements in well-being cancelled out by substantial declines in both mental and physical health morbidity. Healthy places worsened slightly too over the period with improved access to services cancelled out by worsening access to housing. In contrast, the healthy lives domain improved by 1 unit driven by improvements in unemployment and children’s and young peoples’ education despite substantial declines in risk factors such as diabetes obesity.
A north-south divide
The Health Index identified a north-south divide.
- The south-east of England (102.5) and London (101.0) were the healthiest regions while the north east (95.9) and north-west (97.4) were the least healthy.
The LCP Health Index platform helps us to explain why these differences exist through exploring the components that comprise a populations stock of health.
- While the healthy places score higher in the north east (102.4 compared to 98.9) with better access to housing and green space, the healthy people domain is substantially lower at 89.9 (compared with 102.0 in south-east) with experiencing some of the lowest healthy life expectancy and disability that impacts daily living.
Inequalities persist in drivers and health outcomes
The LCP Health Index Explorer enables users to create their own analysis to explore how the index varies across England at local authority level. Looking across all local authorities, more deprived communities, as measured by the index of multiple deprivation score, tended to be less healthy with lower Health Index scores.
- The healthiest and least deprived local authority in 2018 was Wokingham with an index score of 110.1 whilst the most deprived local authority, Blackpool, had a Health Index more than 20% lower at 86.4.
Generally healthy places appear more equitable across regions and local authorities, whereas there are large gaps across the healthy people and healthy lives domain.
- In the former, some of the largest contributors to the gap in the health index are in depression (51.0 in Blackpool vs 95.2 in Wokingham) and avoidable deaths (71.1 vs 121.0), while substantial inequities exist across local authorities in children’s social and mental health (83.9 vs 118.5) alongside smoking (85.4 vs 130.7).
This beta version of the Health Index has been published at a crucial time for the nation’s health. It is the first time we have quantified our stock of health, appreciating the role health plays in our prosperity within and across communities. Through being able to identify the components that account for the variations in the Health Index over time and across populations, by geography and deprivation, this provides the opportunity to take a data driven approach to investing in communities and build back better in 2021.